Choriocarcinoma syndrome in a 24-year-old male

A 24-year-old male, with no medical history, noticed a gradual increase in the size of his left testicle over a period of six months. He consulted a physician because he had headaches, vomiting, fatigue, and mild dyspnea. On physical examination, he was found to be normotensive, with oxygen saturation of 99%. His relevant laboratory data were: Hematocrit 35.8%, LDH 2,345 IU/l (NV 210-420 IU/l), alfa-FP 76.7 IU/l (NV <11 IU/l), HCG >200,000 IU/l (NV <4 IU/l). Chest X-ray evidenced multiple bilateral nodules of welldefined, regular borders (Figure 1). The brain computed-tomography (CT) showed a lesion in the left occipital region with peripheral edema and midline displacement. He was diagnosed with testicular cancer and an orchiectomy was performed. Immediately afterwards, he was treated with combined chemotherapy with bleomycin, etoposide, and cisplatin. Three days later, he presented with a cough, hemoptysis, a rapidly progressive dyspnea and respiratory failure. New laboratory results showed his hematocrit had decreased to 24%. A chest CT showed zones of ground-glass opacity, mainly in the areas surrounding each pulmonary nodule (Figure 2). Bronchoscopy could not be performed because of the patient’s breathing difficulty. He continued the chemotherapy treatment and showed clinical and blood-gas improvement during the following 72 hours. Finally, the case was referred to the oncology service. Afterwards, there were signs of improvement in the chest CT, along with a decrease in human chorionic gonadotropin (HCG) values.